Context:Combined spinal epidural anesthesia (CSEA) has a significant advantage by enabling the use of low dose intrathecal local anesthetic, with knowledge that the epidural catheter may be used to extend the block as necessary. CSEA is useful in high-risk geriatric patients by providing greater hemodynamic stability.Aim:This study is designed to compare the clinical effects of CSEA versus spinal anesthesia in high-risk geriatric patients undergoing surgeries around the hip joint.Materials and Methods:Sixty patients aged >65 years, American Society of Anaesthesiology III and IV were randomly allocated into two equal groups. Group A (n = 30) received CSEA with 1 ml (5 mg) of 0.5% hyperbaric bupivacaine with 25 μg fentanyl through spinal route, and the expected incompleteness of spinal block was managed with small incremental dose of 0.5% isobaric bupivacaine through epidural catheter, 1–1.5 ml for every unblocked segment to achieve T10 sensory level. Group B (n = 30) received spinal anesthesia with 2.5 ml (12.5 mg) of 0.5% hyperbaric bupivacaine and 25 μg fentanyl.Result:Both the groups showed rapid onset, excellent analgesia and good quality motor block. Group A showed a significantly less incidence of hypotension (P < 0.01) along with the provision of prolonging analgesia as compared to Group B.Conclusion:CSEA is a safe, effective, reliable technique with better hemodynamic stability along with the provision of prolonging analgesia compared to spinal anesthesia for high-risk geriatric patients undergoing surgeries around the hip joint.

INTRODUCTIONRegional anesthesia has been accepted as a safe and effective method for various surgical procedures including upper limb surgery. This method can prolong analgesia during surgery and assist with post-operative pain management. A supraclavicular brachial plexus block is commonly used as a regional anesthesia in the hand, arm, and forearm surgeries. Several attempts have been made to prolong the effect of regional anesthetics by sensory and motor blocks of supraclavicular brachial plexus using various factors such as narcotics, verapamil, clonidine, and tramadol. 2 Some studies have demonstrated that the magnesium seems to reduce the postoperative pain, moreover injecting intravenously led to a reduction of the consumption of anesthetics during surgery. 3Studies have also shown that intrathecal administration of magnesium can strengthen the analgesic properties of opioids used for pain management following knee arthroscopy and during childbirth labor. 4 ABSTRACT Background: Magnesium is a physiologic cation that blocks neuromuscular transmission and does not allow the nerve to be stimulated. This study investigates the effect of adding magnesium sulfate to 0.5% bupivacaine to extend the duration of sensory and motor blocks of the supraclavicular brachial plexus in orthopedic surgeries of the upper extremities. Methods: This controlled randomized double-blind study was performed on patients who were candidates for orthopedic surgery of the upper extremities. A total of 60 patients between 18 and 60 years with ASA Class 1 or 2 participated in the study. One Group M received 0.5% bupivacaine (1.5 mg/kg) with magnesium sulfate 20% (3 ml) as the case group, while the second Group P received 0.5% bupivacaine (1.5 mg/kg) with normal saline (3 ml) as a placebo to block the supraclavicular brachial plexus using nerve locator. The duration of the sensory and motor block of the supraclavicular brachial plexus was monitored and evaluated using the pinprick and modifi ed Bromage scale. Results: A total of 60 patients were included in the study with 30 patients having received 0.5% bupivacaine plus magnesium and the other 30 patients having received 0.5% bupivacaine plus normal saline. The mean sensory block duration in the case Group M was 249±9.36 and in control Group P was 160±5.62 (p<0.39). The mean motor block duration in the case Group M was 232±9.64 and in control Group P was 147±26.52 (both p<0.32). The mean onset of sensory block in case Group M was 15.5±2.16 and the onset block in control Group P was 12.73±1.18 (p<0.49; statistically not signifi cant). The mean onset of motor block in case Group M was 23.5±1.1 and the onset block in control Group P was 41±3 (p<0.53; statistically not signifi cant). Conclusions: The addition of magnesium sulfate to 0.5% bupivacaine increased the duration of motor and sensory supraclavicular brachial block in the upper extremities during surgeries when compared to the use of 0.5% bupivacaine alone, though statistically not signifi cant, but defi nitely in clinically signifi...

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Bilateral recurrent laryngeal nerve (RLN) injury is rare for benign thyroid lesions (0.2%). After extubation-stridor, respiratory distress, aphonia occurs due to the closure of the glottic aperture necessitating immediate intervention and emergency intubation or tracheostomy. Intra-operative identification and preservation of the RLN minimizes the risk of injury. It is customary to expect RLN problems after thyroid surgery especially if malignancy, big thyroid, distorted anatomical problems and difficult airway that can lead to intubation trauma. Soon after extubating, it is essential to the anesthetist to check the vocal cord movements on phonation and oropharyngeal reflexes competency. But this case is specially mentioned to convey the message that in spite of absence of above mentioned predisposing factors for complications and good recovery profile specific to thyroid, there can be unanticipated airway compromise that if not attended to immediately may cost patient's life. This is a case of postextubation stridor following subtotal thyroidectomy due to bilateral RLN damage and its management.

Fifty adult male and female surgical patients (age 25--40 years) undergoing elective and emergency surgical procedures were subjected to isocapnoeic, hypocapnoeic and hypercapnoeic ventilation during anaesthesia; the PaCO2 ranged between 22--90 mm Hg. Three developed the syndrome of depressed vital functions in the post-surgical period by scoring less than 7 out of 10, the others recovered normally with complete resotration of reflex activity, consciousness and skeletomuscular tone, scoring on an average 8 out of 10 points. The role of muscle relaxant drugs in this syndrome and also the depression of the central nervous system is discussed.